Abstract
Increasing use of novel systemic treatment options in the management of patients with
advanced hepatocellular carcinoma (HCC) such as antiangiogenic and molecular-targeted
therapies, poses unique challenges for effective treatment monitoring and efficacy
assessment. The traditional morphological criteria such as response evaluation criteria
in solid tumor (RECIST) rely on changes in tumor size to determine treatment efficacy.
However, these criteria based on tumor morphology may not be suitable to monitor response
to newer targeted therapies as early functional changes induced by these drugs precede
changes in tumor size. Modifications of these morphological criteria that determine
response based on tumor enhancement characteristics such as modified RECIST (mRECIST)
will potentially allow improved determination of treatment response pending validation
from prospective trials. Advanced functional imaging techniques such as perfusion
imaging (computed tomography/magnetic resonance imaging [CT/MRI]), diffusion weighted
MRI (DW-MRI) and positron emission tomography (PET/CT and PET/MRI) are being increasingly
used as surrogate imaging biomarkers to provide superior assessment of changes in
tumor physiology. Growing emphasis on precision oncological care tailored to specific
tumor type and individual patients renders the use of these newer imaging modalities
more pertinent and timely. In this review, the authors discuss the role of various
imaging techniques and response assessment criteria in the evaluation of systemic
therapy for advanced HCC with focus on functional imaging tools.
Keywords
hepatocellular carcinoma - computed tomography - magnetic resonance imaging - systemic
therapy - response assessment - RECIST - mRECIST
